Bautista-González S, Guzmán-Chávez OR,Torres-Alcalá F, Soto-Vargas J, Fajardo-Fregoso BF, Rivera-Arana S, Sandoval-Virgen FG, López-Taylor JG

Language: Spanish
References: 14
Page: 134-138
PDF size: 530.53 Kb.

ABSTRACT

Background:The aortic insufficiency (AI) is characterized by a blood diastolic reflux originated from the aorta to the left ventricle (LV) due to malcoaptation of the aortic cusps. There are two mechanisms in which the aortic insufficiency can occur: dilatation of the functional aortic ring and valve pathology. In general, patients with acute symptoms (New York Heart Association class III or IV) must immediately start surgical protocol since it has proved a reduction in the mortality and improves the functional state. The surgery is also indicated when the final diameter of the IV’s systole reaches 55 mm or ejection fraction diminishes. The most common aortic stenosis (AS) in adults is the calcification of the normal tricuspid valve or a congenital bicuspid. The therapeutical decisions are based in whether it has clinical manifestations or not.
Objective:To describe the casuistry of the valve aortic substitution intervention, due to insufficiency, stenosis, or double aortic lesion.
Methods:A descriptive retrospective study with the objective of showing the experience in surgical handling in our hospital during 28 months. 74 records of patients treated with by the service of Thorax and cardiovascular Surgery in the Fray Antonio civil hospital of Guadalajara. We considered the valve lesion type, spare type, extracorporeal circulation time, time of aortic pinch, postsurgical complications and association to mortality was analyzed.
Results:The relation man:woman was 1.5:1. The mean age was 53.3 years old, the most frequent valve lesion was the double aortic lesion with 31 (41.9 %) patients. The most prevalent complication being the bleeding in 17 (23.0%). Death in 12(16.2%) patients. Respiratory failure was associated to a larger mortality (p=0.001 or 6.83), as well as the most time of extracorporeal circulation and aortic pinch (p=0.002 and p=0.028).
Conclusions:Based on the described in the literature and the results obtained in the present, we have acceptable statistics regarding the morbid-mortalities post surgery of valve aortic substitution.

REFERENCES

1. 1.Bekeredjian Raffi and Grayburn Paul A. Valvular Heart Disease : Aortic Regurgitation. Circulation. 2005;112:125-134

2. 2.Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) [published correction appears in Am J Cardiol. 1999;84:1143]. Am J Cardiol. 1999;83:897–902

3. 3.G. El Khoury, D. Glineur, J. Rubay, R. Verhelsta, Y. d'Udekem d'Acoz, A. Ponceleta, P. Astarcia, Noirhomme and M. van Dyck. Functional classification of aortic root/valve abnormalities and their correlation with etiologies and surgical procedures. Curr Opin Cardiol. 2005; 20:115—121.

4. 4.Goldbarg Seth H. and Halperin Jonathan L. Aortic regurgitation: disease progression and management. Nature. 2008; 5, 5.

5. 5.Bonow et al. Guidelines for the Management of Patients With Valvular Heart Disease. JACC 2006; 48,3:e1–148.

6. 6.Steward BF, Siscovick D, Lind B, Gardin J, Gottdiener J, Smith VE et al. Clinical factors associated with calcific aortic valve disease. J Am Coll Cardiol 1997; 29: 630-634

7. 7.Juan Caballero-Borrego, Juan J. Gómez-Doblas, Félix M. Valencia-Serrano, Influencia del sexo en el pronóstico perioperatorio de pacientes sometidos a sustitución valvular por estenosis aórtica severa. Rev Esp Cardiol. 2009;62(1):31-8

8. 8.Alec Vahanian1* and Catherine M. Otto2. Risk stratification of patients with aortic stenosis. European Heart Journal (2010) 31,

9. 9.Lindroos M, Kupari M, Valvanne J, Strandberg T, Heikila J, Tilvis R. Factors associated wth calcific aortic valve degeneration in the elderly. Eur Heart J 1994; 15: 865-870.

10. 10.Steward BF, Siscovick D, Lind B, Gardin J, Gottdiener J, Smith VE et al. Clinical factors associated with calcific aortic valve disease. J Am Coll Cardiol 1997; 29: 630-634

11. 11.David Calvo, Ińigo Lozano, Juan C. Llosa, Cirugía de recambio valvular por estenosis aórtica severa en mayores de 80 ańos. Experiencia de un centro en una serie de pacientes consecutivos. Rev Esp Cardiol. 2007;60(7):720-6.

12. 12.Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement

13. 13.Deleuze P, Loisance DY, Besnainou F, Hillion ML, Aubry P, Bloch G, et al. Severe aortic stenosis in octogenarians: is operation an acceptable alternative? Ann Thorac Surg. 1990;50:226-9. 1

14. 14.Gilbert T, Orr W, Banning AP. Surgery for aortic stenosis in severely symptomatic patients older than 80 years: experience in a single UK centre. Heart. 1999;82:138-42